AN ACT CONCERNING REVISIONS TO THE DEPARTMENT OF MENTAL RETARDATION STATUTES.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1.
Section 17a-248 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

As used in this section and sections 17a-248b to 17a-248g, inclusive, as amended, 38a-490a, as amended, and 38a-516a, as amended, unless the context otherwise requires:

(1) "Commissioner" means the Commissioner of Mental Retardation.

(2) "Council" means the State Interagency Birth-to-Three Coordinating Council established pursuant to section 17a-248b.

(3) "Early intervention services" means early intervention services, as defined in 34 CFR Part 303.
12, as from time to time amended.

(4) "Eligible children" means children from birth to thirty-six months of age, who are not eligible for special education and related services pursuant to sections 10-76a to 10-76h, inclusive, as amended, and who need early intervention services because such children are:

(A) Experiencing a significant developmental delay as measured by standardized diagnostic instruments and procedures, including informed clinical opinion, in one or more of the following areas:
(i) Cognitive development;
(ii) physical development, including vision or hearing;
(iii) communication development;
(iv) social or emotional development;
or (v) adaptive skills;
or

(B) Diagnosed as having a physical or mental condition that has a high probability of resulting in developmental delay.

(5) "Evaluation" means a multidisciplinary professional, objective assessment conducted by appropriately qualified personnel in order to determine a child's eligibility for early intervention services.

(6) "Individualized family service plan" means a written plan for providing early intervention services to an eligible child and the child's family.

(7) "Lead agency" means the Department of Mental Retardation, the public agency responsible for the administration of the birth-to-three system in collaboration with the participating agencies.

(8) "Parent" means the child's parent or a person in a parental relationship to the child.
With respect to a child who has no parent or person in a parental relationship, "parent" means the person designated to serve in a parental relationship for the purposes of this section and sections 17a-248b to 17a-248g, inclusive, as amended, 38a-490a, as amended, and 38a-516a, as amended, pursuant to regulations of the Department of Mental Retardation, adopted in accordance with chapter 54 in consultation with the Department of Children and Families, for children in foster care.

(9) "Participating agencies" includes, but is not limited to, the Departments of Education, Social Services, Public Health, Children and Families and Mental Retardation, the Insurance Department, the Board of Education and Services for the Blind, the Commission on the Deaf and Hearing Impaired and the Office of Protection and Advocacy for Persons with Disabilities.

(10) "Qualified personnel" means persons who meet the standards specified in 34 CFR Part 303.
12(e), as from time to time amended, and who are licensed physicians or psychologists or persons holding a state-approved or recognized license, certificate or registration in one or more of the following fields:
(A) Special education, including teaching of the blind and the deaf;
(B) speech and language pathology and audiology;
(C) occupational therapy;
(D) physical therapy;
(E) social work;
(F) nursing;
(G) dietary or nutritional counseling;
and (H) other fields designated by the commissioner that meet requirements that apply to the area in which the person is providing early intervention services, provided there is no conflict with existing professional licensing, certification and registration requirements.

(11) "Region" means a region within the Department of Mental Retardation.

(12) "Service coordinator" means a person carrying out service coordination, as defined in 34 CFR Part 303.
22, as from time to time amended.

(13) "Primary care provider" means physicians and advanced practice registered nurses, licensed by the Department of Public Health,who are responsible for performing or directly supervising the primary care services for children enrolled in the birth-to-three program.

Sec.
2.
Section 17a-248g of the general statutes, as amended by section 9 of public act 03-3 of the June 30 special session, is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) Subject to the provisions of this section, funds appropriated to the lead agency for purposes of section 17a-248, as amended by this act, sections 17a-248b to 17a-248f, inclusive, this section and sections 38a-490a, as amended, and 38a-516a, as amended, shall not be used to satisfy a financial commitment for services that would have been paid from another public or private source but for the enactment of said sections, except for federal funds available pursuant to Part H of the Individuals with Disabilities Education Act, 20 USC 1471 et seq.
, except that whenever considered necessary to prevent the delay in the receipt of appropriate early intervention services by the eligible child or family in a timely fashion, funds provided under said sections may be used to pay the service provider pending reimbursement from the public or private source that has ultimate responsibility for the payment.

(b) Nothing in section 17a-248, as amended by this act, sections 17a-248b to 17a-248f, inclusive, this section and sections 38a-490a, as amended, and 38a-516a, as amended, shall be construed to permit the Department of Social Services or any other state agency to reduce medical assistance pursuant to this chapter or other assistance or services available to eligible children.
Notwithstanding any provision of the general statutes, costs incurred for early intervention services that otherwise qualify as medical assistance that are furnished to an eligible child who is also eligible for benefits pursuant to this chapter shall be considered medical assistance for purposes of payments to providers and state reimbursement to the extent that federal financial participation is available for such services.

(c) Providers of early intervention services shall, in the first instance and where applicable, seek payment from all third-party payers prior to claiming payment from the birth-to-three system for services rendered to eligible children, provided, for the purpose of seeking payment from the Medicaid program or from other third-party payers as agreed upon by the provider, the obligation to seek payment shall not apply to a payment from a third-party payer who is not prohibited from applying such payment, and who will apply such payment, to an annual or lifetime limit specified in the third-party payer's policy or contract.

(d) The commissioner, in consultation with the Office of Policy and Management and the Insurance Commissioner, shall adopt regulations, pursuant to chapter 54, providing public reimbursement for deductibles and copayments imposed under an insurance policy or health benefit plan to the extent that such deductibles and copayments are applicable to early intervention services.

(e) The commissioner shall establish a schedule of fees based on a sliding scale for early intervention services.
The schedule of fees shall consider the cost of such services relative to the financial resources of the parents or legal guardians of eligible children.
Fees may be charged to any such parent or guardian, regardless of income, and shall be charged to any such parent or guardian with a gross annual family income of forty-five thousand dollars or more, except that no fee may be charged to the parent or guardian of a child who is eligible for Medicaid.
The Department of Mental Retardation may assign its right to collect fees to a designee or provider participating in the early intervention program and providing services to a recipient in order to assist the provider in obtaining payment for such services.
The commissioner may implement procedures for the collection of the schedule of fees while in the process of adopting or amending such criteria in regulation, provided the commissioner prints notice of intention to adopt or amend the regulations in the Connecticut Law Journal within twenty days of implementing the policy.
Such collection procedures and schedule of fees shall be valid until the time the final regulations or amendments are effective.

(f) The commissioner shall develop and implement procedures to hold a recipient harmless for the impact of pursuit of payment for early intervention services against lifetime insurance limits.

(g) Notwithstanding any provision of title 38a relating to the permissible exclusion of payments for services under governmental programs, no such exclusion shall apply with respect to payments made pursuant to section 17a-248, as amended by this act, sections 17a-248b to 17a-248f, inclusive, this section and sections 38a-490a, as amended, and 38a-516a, as amended.
Except as provided in this subsection, nothing in this section shall increase or enhance coverages provided for within an insurance contract subject to the provisions of section 10-94f, subsection (a) of section 10-94g, subsection (a) of section 17a-219b, subsection (a) of section 17a-219c, sections 17a-248, as amended by this act, 17a-248b to 17a-248f, inclusive, this section, and sections 38a-490a, as amended, and 38a-516a, as amended.

(h) Notwithstanding any provision of the general statutes or the regulations of Connecticut state agencies, the signature on an individualized family service plan of an advanced practice registered nurse, working within said nurse's scope of practice in collaboration with a physician licensed to practice medicine in this state, in accordance with section 20-87a, and performing or directly supervising the primary care services for children enrolled in the birth-to-three program, shall be deemed sufficient to order all such services included in the individualized family service plan and shall be deemed sufficient by the Department of Social Services to substantiate a claim for federal financial participation.

Sec.
3.
Section 17a-211 of the general statutes is repealed and the following is substituted in lieu thereof (Effective from passage):

(a) In 1991, and every [two]five years thereafter, the Department of Mental Retardation shall develop and review a five-year plan in accordance with this section.
The plan shall:
(1) Set priorities;
(2) identify goals and objectives and the strategies to be employed to achieve them;
(3) define the criteria to be used in evaluating whether the department is making progress toward the achievement of such goals and objectives;
(4) identify changes in priorities, goals, objectives and strategies from the prior plan;
(5) describe and document progress made in achieving the goals and objectives outlined in the prior plan;
and (6) estimate the type and quantity of staff and client services that will be needed over the life of the plan.

(b) Every [two]five years, the department shall hold public hearings on a complete draft of the plan and, in January, 1992, and every [two]five years thereafter, the department shall submit the final plan and a transcript of the public hearings to the joint standing committees of the General Assembly having cognizance of matters relating to public health and appropriations and the budgets of state agencies.

Sec.
4.
Section 17a-240 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2004):

[(a)] The Commissioner of Mental Retardation shall, within available appropriations, operate a school district within the Department of Mental Retardation, to be known as State of Connecticut-Unified School District #3.
The school district shall provide educational services to persons eligible to receive services from State of Connecticut-Unified School District #3.
The school district shall operate on a twelve-month calendar to provide uninterrupted educational programming.
[There shall be an education council for the school district within the Department of Mental Retardation which shall be composed of seven members to be appointed by the Commissioner of Mental Retardation as follows:
One member from each of the six regions within the Department of Mental Retardation and one member from the Council on Mental Retardation.
The term of each member shall be coterminous with the term of the Governor.
The members of the education council shall be persons with a demonstrated interest in and concern for infants and toddlers with developmental delays, and shall not be employees of the Department of Mental Retardation or the Department of Education.
The education council shall annually elect a chairperson and a secretary from its membership.
The education council shall meet at least four times a year or at such other times as the chairperson deems necessary.
]

[(b) The education council for the school district within the Department of Mental Retardation shall (1) be responsible for planning and maintaining such appropriate educational programs as the education council deems necessary or advisable in the interests of the persons benefiting from such programs, (2) make a continuing study of the educational needs of seriously retarded persons in the state and conduct such planning as is necessary to meet their needs, and (3) report annually to the Commissioner of Mental Retardation regarding the progress and accomplishments of the school district.
]

Sec.
5.
Section 17a-241 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2004):

(a) The Commissioner of Mental Retardation shall, upon the recommendation of the education council of the school district, appoint a superintendent for said district.
Said superintendent shall operate the school district in accordance with the rules and orders of the commissioner and with the policies and programs approved by the education council of said district.
The superintendent shall, subject to the approval of the commissioner, [and upon consultation with the education council,] make rules for the administration of the school system, provided all such rules are in accordance with regulations established by the State Board of Education.

(b) The superintendent of the school district under the general supervision of the Commissioner for Mental Retardation [, and in consultation with the education council of the school district,] shall have the power to (1) establish and maintain within the department a state-wide system of programs as required;
(2) purchase, receive, hold and convey personal property for school purposes and equip and supply such schools with necessary furniture, equipment and other appendages;
(3) make agreements and regulations for establishing and conducting the district's programs and employ and dismiss, in accordance with the applicable provisions of section 10-151, such teachers and other staff as are necessary to carry out the intent of sections 17a-239 to 17a-244, inclusive, and to pay their salaries;
(4) receive any federal funds or aid made available to the state for such programs and shall be eligible for and may receive any other funds or aid whether private, state or otherwise, to be used for the purposes of sections 17a-239 to 17a-244, inclusive.
The superintendent of the school district may cooperate with the federal government in carrying out the purposes of any federal law pertaining to the education of students within said district, and may adopt such methods of administration as are found by the federal government to be necessary, and may comply with such conditions as may be necessary to secure the full benefit of all federal funds available.

Sec.
6.
Section 17a-242 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2004):

The Commissioner of Mental Retardation, together with the superintendent [and education council of the school district,] shall annually evaluate the progress and accomplishments of the school district.
The Commissioner of Mental Retardation shall (1) submit annual evaluation reports to the Commissioner of Education in order to apprise the State Board of Education of the condition, progress and needs of the school district, and (2) follow procedures adopted by the Commissioner of Education in preparation of such annual evaluation reports.

Sec.
7.
Subsection (e) of section 17a-248d of the general statutes, as amended by section 13 of public act 03-174, is repealed and the following is substituted in lieu thereof (Effective from passage):

(e) The state-wide system shall include a system for required notification to any local or regional school board of education no later than January first of each year of any child who resides in the local or regional school district, participates in the state-wide program and will attain the age of three during the next fiscal year.
Such system of notification shall include provisions for preserving the confidentiality of such child and of the parent or guardian of such child.

Sec.
8.
(Effective from passage) Sections 45a-668, as amended, and 17a-283 of the general statutes are repealed.